Nowadays, it’s common for looks-conscious people to consider going under the designer knife to enhance their appearance. However, the high costs dissuade them, as the expenses include the surgeon’s fees, materials such as implants, anaesthesia, operation theatre costs, and post-surgical requirements. Even though a medical procedure, health insurance does not cover plastic or cosmetic surgery, as it’s not vital to one’s health, well-being, safety or quality of life. That said, insurers cover it only if medically necessary and a doctor prescribes a corrective surgery to repair congenital disabilities, deformities, or disfigurement due to an accident or ailment.
Know All About Cosmetic Surgery Coverage
Is cosmetic surgery entirely out of the health insurance ambit? Not really. It only means one cannot buy health insurance plans exclusively for transforming looks and body. One cannot rush into cosmetic surgery simply by presuming that their plan provides the necessary financial backing. The astronomical costs that plastic surgery involves naturally necessitate support. However, a policyholder can avail of health insurance benefits in cases such as:
- Genuine health issues
- Accidents
- Serious medical condition due to an eventuality
- Deformities or defects since birth
Therefore, relying on health insurance claims for cosmetic surgery is not advisable unless your doctor prescribes it as essential for your health and safety. A tummy tuck, for example, could be prescribed only for a person with morbid obesity. Only someone who has had an accident resulting in significant damage to the skin or body parts and needs cosmetic surgery can get coverage. No health insurance policies per se facilitate only look enhancement procedures.
How Much Coverage Can You Receive?
Health insurance coverage for a corrective surgery will depend on hospitalisation costs, pre and post-hospitalisation expenditures, deductibles, and other factors. In general, the type of insurance plan you select and the amount of your maximum sum insured will determine the coverage you are entitled to. The cost of each health insurance plan’s premiums will depend on the degree of coverage it offers.
What Do Health Insurance Plans Cover in Surgeries?
Simply put, your health insurance plan’s ‘maximum sum insured’ will serve as the upper limit on the coverage you may receive for surgeries. If your policy does cover plastic and reconstructive surgeries, it would include:
- Surgeries required after treating cancer or tumours
- Surgeries that fix congenital anomalies such as cleft lips and palates, nasal deformities that obstruct breathing
- Reconstructive surgeries that normalise injuries from trauma
- Reconstruction, grafting and skin tightening surgeries for incidents of burns
- Laceration
- Scar repair
Types of Surgeries a Plan may Cover
Many corrective or life-saving surgeries may be necessary for a policyholder. In that case, one can buy health insurance to remove the financial burden of undergoing it. These surgeries include:
Facial surgery
An insurer will cover surgery to treat deformities of the head, neck, or facial muscles brought on by paralysis.
Septoplasty
A deviated septum may interfere with the patient’s ability to breathe, and some insurers may cover septoplasty. A surgeon may also perform a rhinoplasty, which medical insurance does not cover. Still, patients will manage significant savings as the company covers some of the surgeon’s fees and operation theatre expenses.
Nose Surgery
Your policy may pay for a surgery performed to treat congenital defects, medical conditions, or respiratory issues.
Reduction Mammaplasty
More popularly called breast reduction, an insurer will pay for this if the patient has a long history of neck, back, or shoulder pain that does not improve with physical therapy. However, your insurance provider may require the removal of at least one pound of breast tissue to cover the costs.
Blepharoplasty or Eyelid Surgery
A field of vision exam and other tests can certify that blepharoplasty will rectify the sagging skin around eyelids that impairs one’s ability to see. Under such circumstances, the provider will approve the surgery claim.
Otoplasty or Ear Surgery
Otoplasty to fix malformed ears caused by birth, disease, or injury
Hand Surgery
Insurance will cover procedures to repair deformities such as fused fingers, carpal tunnel syndrome, Dupuytren’s contracture, nerve damage, tendons, and carpal tunnel syndrome.
Surgeries that Health Insurance Excludes
The following are some types of procedures that health insurance does not typically cover:
Hair Transplants
Frequently used to treat male pattern baldness, standard health insurance does not cover these procedures. The number of grafts used determines the price of this procedure, which is essentially the cause of health insurance companies refusal to pay for it.
Liposuction
The surgery to remove fat from the body to alter its contour is frequently combined with breast augmentation and tummy tuck and is one of the priciest cosmetic operations. Health insurance does not cover it.
Rhinoplasty
Also called a ‘nose job,’ this corrective procedure alters the nose’s shape. A policy may cover it only if it corrects respiratory issues, congenital defects or disfigurement due to an accident.
Facelift
Removal of excess facial skin and tightening it gets rid of wrinkles. A facelift also contours the face’s lower half and restores a youthful appearance. Since this is purely to look younger, insurers do not view it as necessary.
Conclusion
Cosmetic surgeries serve two purposes — correcting deformities, disfigurement due to a disease or accident and enhancing one’s looks. Even though a medical procedure is performed by the same practitioner, health insurance does not cover both types of surgeries. It will only approve the proposal form and claim for the corrective surgery since it is crucial to health, safety and quality of life. While opting for a policy, be clear about the purpose of the surgery to get a plan and for a smooth claim settlement.
Read more -
